Termination of Services/ Lay-off Certificate PERSONAL DETAILS OF EMPLOYEE National Insurance Number*National Registration Number*Name First Middle Last AddressDistrictParishSt. LucySt. PeterSt. AndrewSt. JamesSt. JosephSt. GeorgeSt. ThomasSt. JohnSt. MichaelSt. PhilipChrist ChurchZip/Postal CodeTel. No.Cell No.Email EMPLOYER DETAILSName of EmployerEmployer's Registration No.*AddressDistrictParishSt. LucySt. PeterSt. AndrewSt. JamesSt. JosephSt. GeorgeSt. ThomasSt. JohnSt. MichaelSt. PhilipChrist ChurchZip/Postal CodeTel. No.Fax No.EMPLOYMENT DETAILSOccupationPosition within OrganisationDate Employment Commenced Date Format: DD slash MM slash YYYY Date of Termination Date Format: DD slash MM slash YYYY Last date at work Date Format: DD slash MM slash YYYY Last date for which employee will be paid Date Format: DD slash MM slash YYYY State reason for unemploymentWas employee Laid off?YesNoDate of Lay off Date Format: DD slash MM slash YYYY Expected date of re-employment Date Format: DD slash MM slash YYYY OTHER DETAILSIs the employee receiving or entitled to pension from employer?YesNoStart date of pension Date Format: DD slash MM slash YYYY Was holiday pay given to employee who was laid off?YesNoFrom Date Format: DD slash MM slash YYYY To Date Format: DD slash MM slash YYYY Amount of holiday pay? Was the employee dismissed because of his/her own misconduct?YesNoExplainDid the employee voluntarily leave your employment?YesNoHas the employee become unemployed because of stoppage of work attributable to a labour dispute at your workplace?YesNoIs/Was the employee participating in a strike?YesNoAny other relevant details?I declare that the information given on this form is true to the best of my knowledge and belief.Signature of Employer*Date signed* Date Format: DD slash MM slash YYYY WARNING: ANY PERSON WHO MAKES A FALSE STATEMENT IS PUNISHABLE BY A FINE OR TERM OF IMPRISONMENT OR BOTH.